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Liu Y, Bilodeau E, Pollack B, Batmanghelich K. Automated detection of premalignant oral lesions on whole slide images using convolutional neural networks. Oral Oncol 2022; 134:106109. [PMID: 36126604 DOI: 10.1016/j.oraloncology.2022.106109] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/12/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Oral epithelial dysplasia (OED) is a precursor lesion to oral squamous cell carcinoma, a disease with a reported overall survival rate of 56 percent across all stages. Accurate detection of OED is critical as progression to oral cancer can be impeded with complete excision of premalignant lesions. However, previous research has demonstrated that the task of grading of OED, even when performed by highly trained experts, is subject to high rates of reader variability and misdiagnosis. Thus, our study aims to develop a convolutional neural network (CNN) model that can identify regions suspicious for OED whole-slide pathology images. METHODS During model development, we optimized key training hyperparameters including loss function on 112 pathologist annotated cases between the training and validation sets. Then, we compared OED segmentation and classification metrics between two well-established CNN architectures for medical imaging, DeepLabv3+ and UNet++. To further assess generalizability, we assessed case-level performance of a held-out test set of 44 whole-slide images. RESULTS DeepLabv3+ outperformed UNet++ in overall accuracy, precision, and segmentation metrics in a 4-fold cross validation study. When applied to the held-out test set, our best performing DeepLabv3+ model achieved an overall accuracy and F1-Score of 93.3 percent and 90.9 percent, respectively. CONCLUSION The present study trained and implemented a CNN-based deep learning model for identification and segmentation of oral epithelial dysplasia (OED) with reasonable success. Computer assisted detection was shown to be feasible in detecting premalignant/precancerous oral lesions, laying groundwork for eventual clinical implementation.
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Affiliation(s)
- Yingci Liu
- University of Pittsburgh, Department of Biomedical Informatics, 5607, Baum Boulevard, Pittsburgh, PA 15206, USA; Rutgers School of Dental Medicine, 110, Bergen St, Newark, NJ 07101, USA.
| | - Elizabeth Bilodeau
- University of Pittsburgh School of Dental Medicine, 3501 Terrace St., Pittsburgh, PA 15206, USA
| | - Brian Pollack
- University of Pittsburgh, Department of Biomedical Informatics, 5607, Baum Boulevard, Pittsburgh, PA 15206, USA
| | - Kayhan Batmanghelich
- University of Pittsburgh, Department of Biomedical Informatics, 5607, Baum Boulevard, Pittsburgh, PA 15206, USA
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2
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Qi M, Li L, Tang X, Lu Y, Wang M, Yang J, Zhang M. Nicotine promotes the development of oral leukoplakia via regulating peroxiredoxin 1 and its binding proteins. ACTA ACUST UNITED AC 2021; 54:e10931. [PMID: 34076143 PMCID: PMC8186375 DOI: 10.1590/1414-431x2020e10931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/09/2021] [Indexed: 12/24/2022]
Abstract
Tobacco can induce reactive oxygen species (ROS) production extensively in cells, which is a major risk factor for oral leukoplakia (OLK) development. Peroxiredoxin 1 (Prx1) is a key antioxidant protein, upregulated in a variety of malignant tumors. We previously found that nicotine, the main ingredient of tobacco, promotes oral carcinogenesis via regulating Prx1. The aim of the present study was to screen and identify the Prx1 interacting proteins and investigate the mechanisms of nicotine on the development of OLK. Through liquid chromatography-tandem mass spectrometry combined with bioinformatics analysis, the candidate Prx1 interacting proteins of cofilin-1 (CFL1), tropomyosin alpha-3 chain (TPM3), and serine/threonine-protein phosphatase 2A 65 kDa regulatory subunit A alpha isoform (PPP2R1A) were screened in human dysplastic oral keratinocyte cells treated with nicotine. CFL1, TPM3, and PPP2R1A were highly expressed in human OLK tissues. The expression of CFL1 increased and the expression of PPP2R1A decreased in OLK of smokers compared to that in OLK of non-smokers. Nicotine upregulated CFL1 and downregulated PPP2R1A in 4-nitro-quinoline-1-oxide (4NQO)-induced OLK tissues in mice in part dependent on Prx1. Furthermore, the in-situ interaction of CFL1, TPM3, and PPP2R1A with Prx1 were validated in human OLK tissues. Our results suggested that tobacco might promote the development of OLK via regulating Prx1 and its interacting proteins CFL1 and PPP2R1A.
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Affiliation(s)
- Moci Qi
- Beijing Institute of Dental Research, Beijing Key Laboratory, Beijing Stomatological Hospital and School of Stomatology, Capital Medical University, Dongcheng District, Beijing, China.,Department of Clinical Laboratory Medicine, Beijing Shijitan Hospital, Capital Medical University, Haidian District, Beijing, China
| | - Lingyu Li
- Beijing Institute of Dental Research, Beijing Key Laboratory, Beijing Stomatological Hospital and School of Stomatology, Capital Medical University, Dongcheng District, Beijing, China
| | - Xiaofei Tang
- Beijing Institute of Dental Research, Beijing Key Laboratory, Beijing Stomatological Hospital and School of Stomatology, Capital Medical University, Dongcheng District, Beijing, China
| | - Yunping Lu
- Beijing Institute of Dental Research, Beijing Key Laboratory, Beijing Stomatological Hospital and School of Stomatology, Capital Medical University, Dongcheng District, Beijing, China
| | - Min Wang
- Beijing Institute of Dental Research, Beijing Key Laboratory, Beijing Stomatological Hospital and School of Stomatology, Capital Medical University, Dongcheng District, Beijing, China
| | - Jing Yang
- Beijing Institute of Dental Research, Beijing Key Laboratory, Beijing Stomatological Hospital and School of Stomatology, Capital Medical University, Dongcheng District, Beijing, China
| | - Min Zhang
- Beijing Institute of Dental Research, Beijing Key Laboratory, Beijing Stomatological Hospital and School of Stomatology, Capital Medical University, Dongcheng District, Beijing, China
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3
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Torabi M, Afshar MK, Afshar HM, Mohammahzadeh I. Correlation Between Clinical and Histopathologic Diagnosis of Oral Potentially Malignant Disorder and Oral Squamous Cell Carcinoma. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2021. [DOI: 10.1590/pboci.2021.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Molook Torabi
- Kerman University of Medical Sciences, Iran; Kerman University of Medical Sciences, Iran
| | - Marzieh Karimi Afshar
- Kerman University of Medical Sciences, Iran; Kerman University of Medical Sciences, Iran
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Guimarães LM, Diniz MG, Rogatto SR, Gomez RS, Gomes CC. The genetic basis of oral leukoplakia and its key role in understanding oral carcinogenesis. J Oral Pathol Med 2020; 50:632-638. [PMID: 33217066 DOI: 10.1111/jop.13140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 12/23/2022]
Abstract
Oral leukoplakia (OL) is the most common oral potentially malignant disorder, with a global prevalence of 2%-3%, variable malignant transformation rate and incompletely understood aetiology. Considering the subjectivity in oral dysplasia grading, other evaluation methods have been tested as predictors of malignant transformation. DNA ploidy status and loss of heterozygosity signatures have been shown to be good predictive markers of malignant transformation. However, effective markers to predict which lesions will progress to invasive carcinoma and by which mechanisms remain unclear. Recent evidence suggests that dysplasia progression to carcinoma occurs through neutral clonal evolution (i.e. randomly). We focus on the genetic basis of OL, encompassing the gross chromosomal alterations and single-gene mutations, and discuss such alterations in the context of aetiology, clinical presentation and progression. The deeper we understand the genetic basis of OL, the more we approach a better comprehension of the complex and poorly understood process of oral carcinogenesis.
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Affiliation(s)
- Letícia Martins Guimarães
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marina Gonçalves Diniz
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Sílvia Regina Rogatto
- Department of Clinical Genetics, Vejle University Hospital, Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark
| | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, Faculty of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Carolina Cavalieri Gomes
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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5
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Aittiwarapoj A, Juengsomjit R, Kitkumthorn N, Lapthanasupkul P. Oral Potentially Malignant Disorders and Squamous Cell Carcinoma at the Tongue: Clinicopathological Analysis in a Thai Population. Eur J Dent 2019; 13:376-382. [PMID: 31618783 PMCID: PMC6890507 DOI: 10.1055/s-0039-1698368] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objective
Tongue is regarded as one of the common sites of oral squamous cell carcinoma (OSCC). This study aimed to determine the prevalence and clinicopathological profile of OSCC and oral potentially malignant disorders (OPMDs) at the tongue.
Materials and Methods
We retrospectively analyzed clinicopathological characteristics of 208 Thai patients diagnosed with SCC and OPMDs at the tongue in the period from 1996 to 2015. Chi-squared test was used to compare differences between patient’s clinical and histopathological features.
Results
Seventy-eight tongue SCC and 130 tongue OPMD cases were present over the study period. Slight male predominance was found for tongue SCC, while a slight female predominance was present for tongue OPMDs. Both tongue SCC and tongue OPMDs were mostly diagnosed in the old age patients (>40 years old). The majority of tongue SCC and OPMDs occurred at the tip and lateral of the tongue. The most common histologic grading of tongue SCC was well differentiated and no poor differentiation was found in this study. More than a half of tongue OPMDs showed epithelial dysplasia. Both tongue SCC and OPMDs demonstrated no significant correlation between clinical feature and histopathologic diagnosis.
Conclusions
Tongue SCC and OPMDs were particularly found in the elderly population and frequently developed at the tip and lateral of the tongue. Most of tongue OPMDs, particularly all of tongue erythroplakia, exhibited epithelial dysplasia. For dental practitioners, awareness in the early detection and diagnosis of these tongue lesions should be raised.
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Affiliation(s)
- Anchisa Aittiwarapoj
- Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Rachai Juengsomjit
- Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Nakarin Kitkumthorn
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Puangwan Lapthanasupkul
- Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Qi M, Li L, Lu Y, Chen H, Zhang M, Wang M, Ge L, Yang J, Shi N, Chen T, Tang X. Proteome profiling to identify peroxiredoxin 1 interacting protein partners in nicotine-associated oral leukoplakia. Arch Oral Biol 2019; 108:104537. [PMID: 31525533 DOI: 10.1016/j.archoralbio.2019.104537] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/31/2019] [Accepted: 08/21/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Tobacco smoking is one of the main risk factors for oral squamous cell carcinoma (OSCC) and can induce generation of reactive oxygen species (ROS). In our previous studies, we demonstrated that nicotine, the major ingredient in tobacco, can upregulate an important antioxidant enzyme Peroxiredoxin 1 (Prx1), in oral leukoplakia (OLK), an oral precancerous lesion. The underlying regulatory mechanisms, however, remain unclear. This study aims to identify regulatory mechanisms of nicotine and identify Prx1 interacting proteins in nicotine-associated OLK. DESIGN Liquid chromatography-tandem mass spectrometry (LC-MS/MS) combined with bioinformatics analysis was conducted to profile Prx1 binding proteins in human dysplastic oral keratinocyte (DOK) cells. Candidate interaction proteins were further verified using Co-immunoprecipitation (Co-IP), Western blot or Duolink assay in 4-nitro-quinoline-1-oxide (4NQO)-induced OLK in mice and human OLK tissues. RESULTS We identified Thioredoxin (Trx), Nucleolar GTP-binding protein 1 (GTPBP4), GTP-binding protein Di-Ras2 (DIRAS2) and apoptosis signal-regulating kinase 1 (ASK1) as key Prx1 interacting proteins regulated by nicotine. Our data showed that nicotine upregulated Trx, GTPBP4, DIRAS2, and downregulated ASK1 in 4NQO-induced OLK in mice, at least in part dependent on Prx1. The modulations of Trx, GTPBP4, DIRAS2 and ASK1 by nicotine were also found in OLK smokers compared to OLK non-smokers. The in-situ interaction of Trx, GTPBP4, DIRAS2 and ASK1 with Prx1 were validated in human OLK tissues. CONCLUSION Nicotine may promote OLK development via regulating Prx1 binding proteins Trx, GTPBP4, DIRAS2 and ASK1. The results of this study will help to develop therapeutic approaches for OLK in humans targeting Prx1 interacting protein network.
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Affiliation(s)
- Moci Qi
- Division of Oral Pathology, Beijing Institute of Dental Research, Beijing Key Laboratory, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, No. 4 TiantanXili, Dongcheng District, Beijing 100050, China
| | - Lingyu Li
- Division of Oral Pathology, Beijing Institute of Dental Research, Beijing Key Laboratory, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, No. 4 TiantanXili, Dongcheng District, Beijing 100050, China
| | - Yunping Lu
- Division of Oral Pathology, Beijing Institute of Dental Research, Beijing Key Laboratory, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, No. 4 TiantanXili, Dongcheng District, Beijing 100050, China
| | - Hui Chen
- Division of Oral Pathology, Beijing Institute of Dental Research, Beijing Key Laboratory, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, No. 4 TiantanXili, Dongcheng District, Beijing 100050, China
| | - Min Zhang
- Division of Oral Pathology, Beijing Institute of Dental Research, Beijing Key Laboratory, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, No. 4 TiantanXili, Dongcheng District, Beijing 100050, China
| | - Min Wang
- Division of Oral Pathology, Beijing Institute of Dental Research, Beijing Key Laboratory, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, No. 4 TiantanXili, Dongcheng District, Beijing 100050, China
| | - Lihua Ge
- Division of Oral Pathology, Beijing Institute of Dental Research, Beijing Key Laboratory, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, No. 4 TiantanXili, Dongcheng District, Beijing 100050, China
| | - Jing Yang
- Division of Oral Pathology, Beijing Institute of Dental Research, Beijing Key Laboratory, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, No. 4 TiantanXili, Dongcheng District, Beijing 100050, China
| | - Ni Shi
- Division of Medical Oncology, Department of Internal Medicine, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH 43210, USA
| | - Tong Chen
- Division of Medical Oncology, Department of Internal Medicine, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus, OH 43210, USA.
| | - Xiaofei Tang
- Division of Oral Pathology, Beijing Institute of Dental Research, Beijing Key Laboratory, Beijing Stomatological Hospital & School of Stomatology, Capital Medical University, No. 4 TiantanXili, Dongcheng District, Beijing 100050, China.
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7
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Gregorczyk-Maga I, Wachsmann A, Olszewska M, Partyka L. Exhaled carbon monoxide levels correlate with incidence of oral mucosal lesions independent of smoking status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2019; 29:290-300. [PMID: 30375883 DOI: 10.1080/09603123.2018.1541442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 10/24/2018] [Indexed: 06/08/2023]
Abstract
Carbon monoxide (CO) is an important component of tobacco smoke, but also environmental toxicity. This study analyzed possible correlation between exhaled CO level and oral health indicators in two geographically distributed populations during health-promoting public events organized for local communities in cities with high and low environmental pollution in Poland (907 patients). Self-reported, instructor-led, oral health questionnaire was developed to monitor current and previous mucosal lesion incidence. Exhaled CO correlated with subjects smoking status and environmental CO exposure: highest in smoking inhabitants of Krakow (12 ppm), with lower levels in smokers from Kozienice (6.5 ppm) and non-smokers from Krakow (6 ppm), and lowest for Kozienice non-smokers (2 ppm) (p < 0.001). After propensity score matching and adjustment for smoking status, demography and comorbidities odds ratio for mucosal lesion incidence was 1.46 (1.31-1.63), p < 0.001) per 1 ppm increase of exhaled CO level. This result might implicate a possible role of environmental pollution factors in oral health pathology.
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Affiliation(s)
- Iwona Gregorczyk-Maga
- a Department of Pediatric Dentistry, Institute of Dentistry , Jagiellonian University Medical College , Krakow , Poland
| | - Agnieszka Wachsmann
- b Department of Angiology , Jagiellonian University Medical College , Krakow , Poland
| | - Marta Olszewska
- c Department of Pediatrics , Jagiellonian University Medical College , Krakow , Poland
| | - Lukasz Partyka
- b Department of Angiology , Jagiellonian University Medical College , Krakow , Poland
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8
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Mello FW, Miguel AFP, Dutra KL, Porporatti AL, Warnakulasuriya S, Guerra ENS, Rivero ERC. Prevalence of oral potentially malignant disorders: A systematic review and meta-analysis. J Oral Pathol Med 2018; 47:633-640. [PMID: 29738071 DOI: 10.1111/jop.12726] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2018] [Indexed: 01/28/2023]
Abstract
Oral potentially malignant disorders (OPMD) are chronic conditions, which have a higher risk of transformation to oral squamous cell carcinoma. The aim of this systematic review and meta-analysis was to answer the question: "What is the prevalence of oral potentially malignant disorders among adults?" Studies reporting the prevalence of these conditions (leukoplakia, erythroplakia, oral submucous fibrosis [OSMF], and actinic cheilitis) were selected, only studies in which a clinical assessment and histopathological confirmation were performed were included. Of the 5513 studies, 22 met the inclusion criteria for qualitative and quantitative analyses. The risk of bias (RoB) of the selected studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. Seven studies were classified as high risk, 12 as moderate risk, and 3 as low RoB. The meta-analysis showed that the prevalence of OPMD was 4.47% (95% CI = 2.43-7.08). The most prevalent OPMDs were OSMF (4.96%; 95% CI = 2.28-8.62) and leukoplakia (4.11%; 95% CI = 1.98-6.97). OPMDs were identified more commonly in males (59.99%; 95% CI = 41.27-77.30). Asian and South American/Caribbean populations had the highest prevalence rates of 10.54% (95% CI = 4.60-18.55) and 3.93% (95% CI = 2.43-5.77), respectively. The overall prevalence of OPMD worldwide was 4.47%, and males were more frequently affected by these disorders. The prevalence of OPMD differs between populations; therefore, further population-based studies may contribute to the better understanding of these differences.
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Affiliation(s)
- Fernanda Weber Mello
- Postgraduate Program in Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
| | | | - Kamile Leonardi Dutra
- Postgraduate Program in Dentistry, Federal University of Santa Catarina, Florianópolis, Brazil
| | - André Luís Porporatti
- Brazilian Centre for Evidence-based Research, Florianópolis, Brazil.,Department of Dentistry, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Saman Warnakulasuriya
- Department of Oral Medicine, King's College London, London, UK.,WHO Collaborating Centre for Oral Cancer, London, UK
| | - Eliete Neves Silva Guerra
- Laboratory of Oral Histopathology, School of Health Sciences, University of Brasília, Brasilia, Brazil
| | - Elena Riet Correa Rivero
- Department of Pathology, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Brazil
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Porter S, Gueiros LA, Leão JC, Fedele S. Risk factors and etiopathogenesis of potentially premalignant oral epithelial lesions. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:603-611. [PMID: 29891084 DOI: 10.1016/j.oooo.2018.03.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/03/2018] [Accepted: 03/06/2018] [Indexed: 12/27/2022]
Abstract
Potentially malignant oral mucosal disease has some ability to give rise to malignancy of the oral epithelium, that is, oral squamous cell carcinoma (OSCC). The present article provides a succinct review of the possible or probable causes of potentially premalignant oral epithelial lesions. There is a focus upon studies that examined the causes or etiologic associations with clinically likely or histopathologically detectable oral epithelial dysplasia.
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Affiliation(s)
| | - Luiz Alcino Gueiros
- Oral Medicine Unit. Departamento de Clínica e Odontologia Preventiva, Universidade Federal de Pernambuco, Brazil
| | - Jair Carneiro Leão
- Oral Medicine Unit. Departamento de Clínica e Odontologia Preventiva, Universidade Federal de Pernambuco, Brazil
| | - Stefano Fedele
- UCL Eastman Dental Institute, London, UK; Oral Theme of the UCL/UCLH NIHR Biomedical Research Centre, UK
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Miyahara LAN, Pontes FSC, Burbano RMR, Conte Neto N, Guimarães DM, Fonseca FP, Pontes HAR. PTENallelic loss is an important mechanism in the late stage of development of oral leucoplakia into oral squamous cell carcinoma. Histopathology 2017; 72:330-338. [DOI: 10.1111/his.13381] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/16/2017] [Accepted: 08/30/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Ligia A N Miyahara
- Oral Diagnosis Department, Semiology and Oral Pathology Areas; Piracicaba Dental School; University of Campinas (UNICAMP); São Paulo Brazil
| | - Flávia S C Pontes
- João de Barros; Barreto University Hospital (HUJBB); Federal University of Pará (UFPA); Pará Brazil
| | - Rommel M R Burbano
- João de Barros; Barreto University Hospital (HUJBB); Federal University of Pará (UFPA); Pará Brazil
| | - Nicolau Conte Neto
- João de Barros; Barreto University Hospital (HUJBB); Federal University of Pará (UFPA); Pará Brazil
| | - Douglas M Guimarães
- João de Barros; Barreto University Hospital (HUJBB); Federal University of Pará (UFPA); Pará Brazil
| | - Felipe P Fonseca
- Department of Oral Surgery and Pathology; School of Dentistry; Federal University of Minas Gerais (UFMG); Minas Gerais Brazil
| | - Hélder A R Pontes
- Oral Diagnosis Department, Semiology and Oral Pathology Areas; Piracicaba Dental School; University of Campinas (UNICAMP); São Paulo Brazil
- João de Barros; Barreto University Hospital (HUJBB); Federal University of Pará (UFPA); Pará Brazil
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